HomeMy WebLinkAboutBCOI-23-1810 dining 2024 � og YAK , TOWN OF YARMOUTH
,, , 27.0. Office of the Building Commissioner
fr 7 1146 Route 28, South Yarmouth, MA 02664
Q,� 508-398-2231 ext. 1260 Fax 508-398-0836
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�` ` APPLICATION FOR CERTIFICATE OF INSPECTION
November 06, 2024 PAYABLE UPON RECEIPT
(X) Fee Required$100.00
( ) No Fee Required
In accordance with the provisions of the Massachusetts State Building Code, Section 110.7, I hereby apply for a
Certificate of Inspection for the below-named premises located at the following address: ,/�
Street and Number: a� L9or+(,t Irl�t & c5{-r b n ✓I k +',"
Name of Premises:liki l4 Jiul I1V'5 -k CLe. ix4( Tel: 5 -310 -3SIy
Purpose for which permit is used: Ala(S:K IL-i.w _ 14-( c .e
License(s) or Permit(s)required for the premises by of er governmental agencies:
License or Permit Agency
R E C E L V ! a
Certificate to be issued to Tel: r 2a2�4�
Address: DEC 2 3
Owner of Record of Building U a- .Ep��n ,T
Address B - —1--«1- !!
Present Holder of Certificate
Signature of person to whom Title
Certificate is issued or his agent
Date
Email Address: A,Lo se, ,-12g04.„s 1 . 6c7
Instructions: Make check payable to: Town of Yarmouth
1146 Route 28, South Yarmouth, MA 02664
Return this application to: Building Inspector's Office
Please note: Application form with accompanying fee must be submitted for each building or structure or part
thereof to be certified. Application must be received before the certificate will be issued. The building official shall
be notified within ten(10)days of any change in the above information.
PLEASE SEND US A COPY OF YOUR WORKER'S COMPENSATION INSURANCE FORM WITH THIS
APPLICATION OR WE CANNOT ISSUE YOUR CERTIFICATE OF INSPECTION.
Certificate of Inspection#
10/10/2023-10/10/2024 Wd/—, 3 —/ ,g--iO